In this issue LTOL Moving On Cardiff Bay Beckons What Will it Be

ACBNews
The Association for Clinical Biochemistry & Laboratory Medicine | Issue 621 | January 2015
In this issue
LTOL
Moving On
Cardiff Bay
Beckons
What Will
it Be Like in
the 2020s?
About ACB News
The Editor is responsible for the final
content. Views expressed are not
necessarily those of the ACB.
Editor
Dr Jonathan Berg
Department of Clinical Biochemistry
City Hospital
Dudley Road
Birmingham B18 7QH
Tel: 07792-912163/0121-507-5353
Fax: 0121-507-5290
Email: jon@bergfamily.co.uk
Associate Editors
Mrs Sophie Barnes
Department of Clinical Biochemistry
12th Floor, Lab Block
Charing Cross Hospital
Fulham Palace Road
London W6 8RF
Email: sophie.barnes@imperial.nhs.uk
Mr Ian Hanning
Department of Clinical Biochemistry
Hull Royal Infirmary
Anlaby Road
Hull HU3 2JZ
Email: ian.hanning@hey.nhs.uk
Dr Derren Ready
Microbial Diseases
Eastman Dental Hospital
University College London Hospitals (UCLH)
256 Gray’s Inn Road
London WC1X 8LD
Email: derren.ready@phe.gov.uk
Mrs Louise Tilbrook
Department of Clinical Biochemistry
Broomfield Hospital
Chelmsford
Essex CM1 5ET
Email: louise.tilbrook@meht.nhs.uk
ACBNews
The monthly magazine for clinical science
Issue 621 • January 2015
General News
page 4
Practice FRCPath Style Calculations
page 9
Council Matters
page 11
Current Topics
page 12
Meeting Reports
page 14
Patient Power
page 16
Personal View
page 18
ACB News Crossword
page 23
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© Association for Clinical Biochemistry &
Laboratory Medicine 2015
Front cover: The LTOL
management team celebrate ten
years of LTOL-UK
Issue 621 | January 2015 | ACB News
4 | General News
Top 100 Scientists Celebration
At the December Council Meeting awards
were presented to the winners of the top 100
Scientists. To identify its list of 100, the Science
Council organised a competition around ten
different ‘types’ of Scientist roles making
valuable contributions across UK society and
economy. Each type of role in science draws on
a different mix of skills, knowledge and
expertise. The ten areas that were judged
were explorer, investigator, developer/
translational, service provider/operational,
monitor/regulator, entrepreneur,
communicator, teacher, business/marketing
and policy maker.
The ACB nominated individuals in some of
the categories of ‘10 types of Scientist’,
identifying individuals who are currently
engaged with UK science that other Scientists
might look to for leadership in their sector or
career. Out of the top 100 Scientists the six
winners are as follows:
Develop-Translational Scientist:
◆ Dr Paul Collinson
Monitor-Regulator Scientist:
◆ Dr Catherine Sturgeon
Service Provider-Operational Scientist:
◆ Professor Heather Cubie
◆ Professor Christopher Price
◆ Dr John Honour
Entrepreneur Scientist:
◆ Dr Jonathan Middle
This was a special presentation event
reflecting the work of some great Scientists
who are part of our thriving association. ■
Cathie Sturgeon, Eric Kilpatrick, John Honour,
Chris Price and Jonathan Middle, four of the six
ACB Members who made the “Top 100 Scientists” list
in 2014
Sudoku
This month’s puzzle
Last month’s solution
ACB News | Issue 621 | January 2015
6 | General News
Barnes Quality Review of Pathology
It is just a year since the Pathology Quality
Assurance Review was published. The review
was chaired by Dr Ian Barnes and followed
incidents in Pathology that warranted a
detailed study of the Quality Assurance
framework for Pathology. NHS England is now
working along with others to implement the
recommendations of the review.
Quality systems are increasingly to the
forefront of the Pathology Department,
especially as the new inspections by UKAS are
now taking place. During 2015 ACB News will
be looking to promote good practice in quality
in the clinical laboratory. Ian Barnes himself is
very keen to see greater understanding of the
Quality Review, and is concerned that
laboratories locally consider the wider aspects
of the review. Ian is still busy being asked to
speak around the country on his review at
meetings and also more locally within
Pathology laboratories. As part of this, Ian has
recently helped with the production of a series
of short training videos. These seek to inform
all Pathology staff about the work of the
review and how it is being taken forward.
Pathology and Trust Board
These resources can be used to help increase
awareness in pathology of quality and how
things are changing in our environment.
The first of a series of five videos looking
Click on this thumbnail to go to the video from the
PDF edition or put the title into YouTube
specifically at the Barnes Quality Review is
now published. “Barnes Quality Review;
Introduction and Governance” sets the scene
and then considers the key issues of how
Pathology interacts with the organisation in
which it is based. The video sees Ian
interviewing a Trust Chairman about the role
of the Board in Pathology oversight.
Dr David Burnett also features in the series
and with his huge commitment to clinical
laboratory quality systems he will be
providing a real foundation of how ISO 15189
can be embedded in Pathology. To play the
video simply click on the images on the
electronic version of ACB News. Alternatively
go onto YouTube and search for: “Barnes
Pathology Quality Review: Introduction and
Governance”. ■
Ian Barnes explains his review to the “St Elsewhere’s” Pathology Directorate at their annual strategic planning
meeting
ACB News | Issue 621 | January 2015
General News | 7
ACB Membership Awards
2015
Nominations for this year’s Awards
are invited from Regional Committees,
together with a citation of about 500
words, outlining the basis of the
nomination.
The Award must be approved by Council
at its meeting in March 2015, and it is
important that the Regional representative is
able to extol the virtues of the nominee as it is
possible that Council members may not know
some of the activities of nominated
individuals.
The three award categories are:
Emeritus Member
Persons who have been Ordinary Members of
the Association for at least ten years and have
retired from full-time employment and who
have made an exceptional contribution to the
objects of the Association may, on the
recommendation of Council and by a majority
of at least two-thirds of those voting at a
General Meeting, be elected Emeritus
Members of the Association.
Fellow
Persons who have been Ordinary or Affiliate
Members of the Association for at least ten
preceding consecutive years and have retired
from full-time employment may, on the
recommendation of Council and by a majority
of at least two-thirds of those voting at a
General Meeting, be elected to the category
of Fellow of the Association. The recipients
have made a significant contribution to the
profession in one or more of the following
areas:
◆ Continually led and instigated changes to
meet the needs of Clinical Biochemistry
and Laboratory Medicine services on
behalf of a region or nationally.
◆ Developed exceptional educational
and/or training facilities for the
profession.
◆ Led in setting up and developing over,
a considerable period of time,
a well-respected and valued specialised
service that had a major impact either
within a region or nationally.
◆ Raised the profile of the profession
over many years, within the lay or
clinical community, either regionally or
nationally.
Honorary Member
Persons who have made a distinguished
contribution to Clinical Biochemistry and
Laboratory Medicine at international level
may, following the recommendation of
Council and by a majority of at least
two-thirds of those voting at a General
Meeting, be elected Honorary Members of
the Association.
If you would like to propose someone then
contact your ACB Regional Secretary.
Proposals must be supported by the Regional
Committee and the nomination submitted
through the Regional Committee at the
Council meeting in March 2015.
The closing date for nominations received
by Council is 2nd February 2015. ■
Issue 621 | January 2015 | ACB News
8 | General News
Science on the Bay
Gina Sanki, Focus Committee
Focus is an event that no ACB Member should
miss out on. It is an opportunity to develop
our learning, share good practices
and look to the future with colleagues.
Accompanying this month’s ACB news you will
find enclosed your Invitation to Participate.
The theme for Focus 2015 in Cardiff is
“Breaking Barriers in Laboratory Medicine”.
Topics that will be covered include genetics
and genomics, porphyria, metabolic muscle
disease, haematology, immunology and
point of care testing, with the full scientific
programme listed in the Invitation to
Participate.
SpR and Trainees Meeting
A satellite meeting for SpRs on Tuesday 9th
June 2015, has a programme aimed towards
SpRs but is open to everyone. Topics at the
satellite meeting include obesity and bariatric
surgery, drug analysis and the legal issues this
presents.
For those at the beginning of their careers in
Biochemistry and Microbiology there is the
Trainees’ Day being held on Monday 8th June,
prior to the main meeting, with the Trainees’
social event held on Sunday 7th June.
This provides
an excellent
occasion to
catch up with
those who
you have
previously
met during
your training
and also to
make new
friends and
contacts.
The first
Award Lecture to be presented at Focus 2015
will be the ACB Foundation Award Lecture by
Professor Stephen Halloran MBE on
Colorectal Cancer Screening on Tuesday 9th
June. Professor Halloran set up the NHS Bowel
Cancer Screening Programme’s Southern
Hub in 2006. The hub now serves 14.3 million
people across the South and, under Professor
Halloran’s watch, more than 1,400 bowel
cancers have been identified.
We look forward to seeing you in Cardiff.
Diolch! ■
Come and Contribute to ACB News . . .
ACB News is aiming to have some fun in
2015. If you would like to be part of this
then do consider contributing. In particular,
we are looking for articles that help take
clinical laboratory medicine forward.
You might want to write about:
◆ Novel ways of improving pathology
transport.
◆ Experience of key performance
indicators with primary care.
◆ Your first UKAS inspection.
◆ Coping with out-of-hours services with
lack of registered staff.
You may of course have your own ideas. If you have,
do give the Editor a phone call or email. ■
ACB News | Issue 621 | January 2015
Practice FRCPath Style Calculations | 9
Deacon’s Challenge
No 164 - Answer
A neonate weighing 850 g is admitted to the Neonatal Intensive Care Unit. Following intubation
and artificial ventilation, blood gases reveal an arterial blood hydrogen ion concentration of
120 nmol/L and a pCO2 of 6.2 kPa. Estimate the dose of sodium bicarbonate (1.25%) required to
reduce the hydrogen ion concentration to 80 nmol/L. You should assume that ventilator settings
remain unchanged, and ignore any effects due to changes in plasma volume and peripheral
circulation. You should assume also that the total body water in neonates is 80% of body mass,
due to an expansion of extracellular fluid volume compared to adults, and is evenly distributed
between intra- and extracellular compartments.
FRCPath, Autumn 2013
The hydrogen ion concentration (in nmol/L), multiplied by the bicarbonate concentration
(in mmol/L) and divided by the pCO2(in kPa) is always constant at 180:
180
[H+] [HCO3–]
=
pCO2
To calculate the initial bicarbonate concentration substitute:
[H+]
so that 180
= 120 nmol/L and pCO2 = 6.2 kPa
= 120[HCO3–]
6.2
[HCO3–] =
180 x 6.2 = 9.3 mmol/L
120
Similarly substitute [H+] = 80 nmol/L in order to calculate the final plasma bicarbonate
concentration (assume pCO2 is still 6.2 kPa since the ventilator settings remain unchanged):
180
=
[HCO3–]
80[HCO3–]
6.2
=
180 x 6.2
80
=
14.0 mmol/L
Therefore administration of bicarbonate has increased the plasma bicarbonate concentration by
14.0 – 9.3 = 4.7 mmol/L
A smaller amount of bicarbonate has been consumed in reducing the [H+] from 120 to 80
nmol/L. i.e. 40 nmol/L of hydrogen ions have been neutralized by the administered bicarbonate.
Therefore another 40 nmol/L = 0.00004 mmol/L are needed, which is small enough to be
ignored.
Assuming administered HCO3– remains in the ECF and is not metabolized:
Change in HCO3– (mmol/L)
=
Amount of NaHCO3 given (mmol)
ECF vol (L)
Issue 621 | January 2015 | ACB News
10 | Practice FRCPath Style Calculations
ECF vol (L)
4.7
=
=
Body wt (Kg) x % body water x Proportion of water in ECF
=
0.85 x 80 x 1
100
2
=
0.34 L
Amount of HCO3– needed (mmol)
0.34
Amount of HCO3– needed
= 4.7 x 0.34
=
1.60 mmol
Calculate concentration of sodium bicarbonate solution (1.25%) in mmol/L:
MW NaHCO3– = 23 + 1 + 12 + (3 x 16) = 84
Therefore [HCO3–]
= 1.25 x 10 x 1000
84
= 149 mmol/L
Volume needed (L) = Amount needed (mmol)
Concentration (mmol/L)
= 1.60 = 0.0107 L i.e. 10.7
149
Question 165
An inherited metabolic disease is due to a gain in function of enzyme X. The erythrocyte
activity of X was measured in 100 normal subjects and 100 patients with the disease.
The 95% confidence limits of the two groups are:
Unaffected:
Diseased:
89 – 901 IU/L red cells
830 – 5260 IU/L red cells
The data from the unaffected group showed a normal Gaussian distribution. However, the
data from the diseased group were markedly skewed but a simple logarithmic
transformation produced a reasonable Gaussian distribution.
It is proposed to use the assay of X in erythrocytes as a screening test for the disease.
Calculate the decision level which will result in a sensitivity of 95%. What specificity will this
achieve?
Two tailed z-distribution:
P(%)
10
5
z
1.65
1.96
2
2.33
1
2.58
0.2
3.09
0.1
3.29
FRCPath, Spring 2014
ACB News | Issue 621 | January 2015
Council Matters | 11
The 2014 Awards Went to . . .
At a recent Council Meeting the Annual ACB
Awards Ceremony was held. These Awards are
designed to recognise Ordinary Members of
the Association who have made a significant
contribution to the work of the Association
and have retired from full time working.
There are three awards, Emeritus, Fellow and
Honorary. The nominations for these Awards
come from each of the regions and are
recommended by ACB Council and by a
majority of at least two thirds of those voting
at a general meeting. The awards for this year
are as follows:
the Association for at least ten years and have
retired from full-time employment and who
have made an exceptional contribution to the
objects of the Association:
◆ Dr Keith Griffiths, Wales
◆ Mrs Ruth Lapworth, Southern
◆ Dr Nigel Lawson, Trent Northern &
Yorkshire
Fellow Members
Persons who have been Ordinary or Affiliate
Members of the Association for at least ten
preceding consecutive years and have retired
from full-time employment:
Honorary Members
Persons who have made a distinguished
contribution to Clinical Biochemistry and/or
Laboratory Medicine at international level:
◆ Dr Penny Clark, West Midlands
◆ Mr Martyn Egerton, Southern
◆ Ms Roberta Goodall, South West &
◆ Mr Mike Hallworth, West Midlands
◆ Dr Ian Watson, North West
◆ Dr Geoff Beckett, Scotland
◆ Dr Charles Van Heyningen, North West
◆ Mr Gethin Roberts, Wales
◆ Mr Colin Samuell, Southern
Emeritus Members
Persons who have been Ordinary Members of
Our congratulations go to all recipients of
these Awards. ■
Wessex
Issue 621 | January 2015 | ACB News
12 | Current Topics
Demonstrating Personal
Proficiency in Pathology
Professor Eric Kilpatrick, ACB President and
Dr Bernie Croal Chair, RCPath SAC on Clinical Biochemistry
The ACB and the Royal College of Pathologists
have released a draft document for
consultation on the topic of demonstrating
personal proficiency with a deadline for
responses of 30th January 2015
(http://www.acb.org.uk/whatwesay/acb_newsp
age/2014/12/10/demonstrating-personalproficiency-in-pathology). All members of the
ACB received the document by email and it
has been included in the College consultations
page. This current article is intended to give an
overview of the purpose and aims of the
document.
pathology results and providing clinical advice
should be registered with current External
Quality Assessment (EQA) individual
assessment schemes and demonstrate regular
participation. Since the report publication,
NHS England has established an Oversight
Group to supervise the implementation of all
the Quality Review recommendations and the
Professional Bodies, including the ACB, have
been tasked with helping deliver many of
them, including the one related to individual
assessment.
Why Demonstrate Personal
Proficiency?
In recommending the need for individual (or
personal) EQA, Ian Barnes, as the Chair of the
Review, did not specifically associate personal
proficiency solely with participation in
individual EQA. This is certainly in keeping
with the view of the document currently out
for consultation which emphasises that
individual EQA schemes can only ever be a
part of demonstrating personal proficiency
and that there are many other ways in which
safe practice can also be proven. These include
(but are not limited to): continued CPD;
evidence of innovating and improving service
quality, either as an individual, as a leader
and/or as part of a team; demonstrating
valued teaching or training supervision;
feedback from colleagues, other staff and
service users (ideally as part of a 360°
appraisal); and recording compliments and
complaints.
It is self-evident that maintaining proficiency
in the job we do as clinical scientists or medics
is our professional duty which is why UK
registration bodies such as the HCPC and the
GMC make it an explicit requirement for
continued practise. In this respect, most
Pathology staff already take part in appraisal
and participate in schemes which demonstrate
their continuing professional development.
Also, as part of their usual work, they are
central to improving the quality of service to
patients.
Why Now?
Although most laboratory staff already have
the means of demonstrating their own
proficiency, the Pathology Quality Assurance
Review (PQAR) (http://www.england.nhs.uk/
publications/ind-rev/) published in January
2014 advised that demonstrating proficiency
should become more formalised through the
development of methodologies which would
give a fair and accurate indication of an
individual’s competence to practise. As part of
this, the Review recommended that all
practising individuals responsible for reporting
ACB News | Issue 621 | January 2015
The Professional Body Response
Challenges
There are challenges in implementing the
draft document which include how
interpretative EQA schemes will be able to
adapt to meet the recommendations of the
PQAR and how having proficiency questioned
might affect individuals.
Current Topics | 13
The interpretative comments EQA scheme
organisers recognise that the schemes in their
current forms will not be able to fulfil the role
envisaged by the PQAR, not least because of
capacity issues if everyone eligible applied at
once. Also, these schemes focus mainly on
education rather than assessment, with
laboratories frequently submitting joint
responses. It means that the system itself will
have to evolve to provide individual
assessment of the necessary while excluding
an obligation to have wide knowledge of
the obscure. Of course, this is further
complicated by the fact that there are also
many sub-specialists in our profession who
will need to be catered for.
With regard to discussing the adequacy of
personal proficiency, it is suggested that the
most appropriate setting should be the locally
based appraisal system. While this form of
discussion is already part of appraisal and
revalidation for medical staff, it is appreciated
that it may mean a change to the way in
which clinical scientists undergo this process.
The document makes it clear that the appraisal
discussion should continue to be supportive,
concentrating on identifying the individual’s
development needs rather than being
regarded as potentially punitive.
The Future
It seems better for the profession to lead on
how personal proficiency should be assessed
rather than it be imposed in what could be a
more imperfect manner. It is therefore
important that the draft document is given
careful consideration and that ACB Members
respond to the consultation with any
suggestions as to how it might be improved. ■
Issue 621 | January 2015 | ACB News
14 | Meeting Reports
Early Detection of Disease
Dr Sally Thirkettle, Cwm Taf UHB
This year the ACB Wales
Autumn Regional and Audit
Meeting found us in Newport,
with a focus on early
detection of disease being
a major function of the
laboratory, to facilitate
appropriate and timely
patient management
First to take to the stage was Dr Rachel Brixey,
Trainee Clinical Scientist, Cardiff and Vale
University Health Board. Rachel presented two
fascinating and informative cases of kidney
stones, one of which was in a young girl that
had sadly caused irreparable kidney damage,
really highlighting the importance of quick
diagnosis and treatment. Next up was Gareth
Davies, Clinical Scientist with WEQAS, who
told us of the latest developments in the
generation of an EQA Scheme for POCT
creatinine. This test could be used in secondary
care as a screen for renal damage before
commencing a patient on a regime of
nephrotoxic drugs for example. Great progress
has been made on this, and the next step is to
put the scheme forward for UKAS
accreditation. To conclude this set of short
presentations Sarah Tennant, Clinical Scientist,
Cardiff and Vale University Health Board,
presented a review of the effect of changing
cortisol assays, from the Siemens Centaur to
the Abbot Architect, in 2010. Sarah carried out
this review in conjunction with the paediatric
endocrine team as concerns were initially
raised about over-investigating patients
secondary to lower results being reported with
the new assay. However, this was not found to
be the case, and clinicians were more
considered when requesting the test, only
requesting it when there were good clinical
grounds to do so.
ACB News | Issue 621 | January 2015
L-R: Rachel Brixey, Sarah Tennant, John Tovey and
Gareth Davies
First prize for the Trainee members
presentation went to Sarah Tennant, but due
to the high quality of all the talks Dr Rachel
Brixey and Gareth Davies also won a prize!
Congratulations to you all.
AKI is Common, Costly and Poorly
Managed
The trainee talks were followed by an
excellent presentation by Dr Edmund Lamb,
Consultant Clinical Scientist, East Kent
Hospitals University NHS Foundation Trust.
Dr Lamb demonstrated how we can use
biological variation within individuals to
better understand the markers used to
diagnose kidney disease. Dr Lamb highlighted
the significant range of inter- and
intra-individual variation, in both health and
disease, which has a direct impact on the key
analytes used to determine renal function.
This impacts on how clinicians should interpret
results and highlights the need to be cautious
in diagnosing patients solely using standard
reference ranges.
The afternoon session was divided into two:
consisting of three audit presentations
recently carried out in Wales, followed by a
presentation given by Dr Richard Body,
Meeting Reports | 15
Consultant in Emergency Medicine at
Manchester Royal Infirmary.
The first audit was presented by Miss Gina
Sanki, Clinical Scientist, Cwm Taf Health Board,
on Acute Kidney Injury (AKI). AKI is currently a
priority in the NHS due to it being common,
costly, often poorly managed and avoidable.
The aim of this audit was to determine
whether AKI is being identified and managed
appropriately in secondary care at North Cwm
Taf. 45% of cases were not recognised as
being AKI, leading to the development of a
strategy to improve AKI identification which
has now been implemented across Cwm Taf
University Health Board. Following this,
Avril Wayte, Consultant Clinical Scientist,
Betsi Cadwaladr University Health Board,
and Annette Thomas, Consultant Clinical
Scientist, WEQAS, presented on troponin.
Avril Wayte presented results of an audit
aimed to investigate the potential differences
between analytical platforms and protocols
used for measuring and reporting troponin
concentrations across Wales, and facilitate
standardisation across the principality.
Clinicians View on Sensitive
Troponin
However, the results demonstrated that a
range of troponin assays are still being used
with some way still to go until all labs
standardise their assays. Annette Thomas
assessed the current performance of troponin
assays in Wales by determining the level of
intra- and inter-laboratory variation at
different concentrations of troponin. It was
demonstrated that whilst the assays currently
in use are clinically useable, some showed less
variability than others. Collectively, these three
audits provided a valuable insight into the
current practices used in early diagnosis of
AKI and MI.
To draw a fantastic day of great quality talks
to a close, Dr Richard Body gave an engaging
and energetic talk on the clinician’s
perspective on the clinical utility of high
sensitivity troponin testing. Dr Body
Festive ACB Trainees welcome event, post ACB Wales
Meeting with Gina Sanki, Rachel Brixey,
Sally Thirkettle, Daniella Nice, Leanne Kelly,
Sarah Tennant, Jonathan Howe and Elizabeth Palmer
highlighted the need for sensitive and specific
biomarkers for acute coronary syndrome,
due to the variability in clinical symptoms,
but emphasised that they must be used with
care as a positive test result is not necessarily
diagnostic of an acute myocardial infarction.
However, exciting new data showed that
under certain situations AMI could be ruled
out in 3 hours, preventing unnecessary
hospital stays for patients. In addition, an
algorithm combining clinical observations
with biochemical analysis for determining
the probability that patients are having an
MI is being trialled, so there will likely be
new developments to watch out for in the
future!
I would like to take this opportunity to
thank Dr Angharad Shore and Mr Gareth
Davies for organising such an informative day.
I and all those present gained new knowledge
and understanding from this meeting and
provided considerable scope for reflection on
current practice within the laboratory.
May I thank Miss Gina Sanki for organising an
opportunity for the new STP Trainees in Wales
to meet after the meeting and to the ACB for
providing the refreshments for the evening. ■
Issue 621 | January 2015 | ACB News
16 | Patient Power
Lab Tests Online-UK into
Second Decade
Ten Years of Lab Tests
Online-UK: Launching the
Champion Role, Technical
and Editorial Update
This has been an exciting year for Lab Tests
Online-UK. We celebrated our ten year
anniversary at EuroLabFocus. A speech from
UK Board Chair Dr Danielle Freedman
provided an overview of Lab Tests Online and
planned future activities. The celebration was
well attended including patient representative
Dr Patricia Wilkie OBE and GP Dr Amir Hannan.
A video of the speech can be seen via our
homepage (www.labtestsonline.org.uk).
If you are reading the electronic version of
ACB News just click anywhere on this page to
go to the video.
Could you be a Lab Tests Online-UK
Champion?
As part of our celebrations we have launched
a champion role to promote the website to
patients and healthcare professionals to
ensure its place as the recommended website
for laboratory medicine information in
the UK. Champions can sign up via
http://www.labtestsonline.org.uk/show-your-
support/ to receive a champions pack which
includes our facts and figures, a prepared
powerpoint presentation to be used and
edited as the Champion wishes and examples
of our newly revised literature including
leaflets and posters. There is also an
opportunity to sign up for our e-newsletter to
be kept up to date with the activities of
Lab Tests Online-UK and the board members,
as well as request leaflets and posters for
your local area. For more information on
our champion role please contact
Rebecca Leyland, Champion Manager,
(rebecca.leyland@ldh.nhs.net).
Technical Report: Site Visitors
The website has continued to receive around
150,000 hits per month, second only to the US
when compared to other countries. The
majority of users (~80%) coming to the site
arrive via Google. Our reliance on Google
search ranking presents a challenge because
the site is in constant competition with others
to reach our target audience. The risks of this
dependence were made abundantly clear to us
recently when a Google search algorithm
update dropped our average Google search
ranking well beyond the first page of results.
The impact was devastating – a 50% reduction
in hit rate almost overnight. We have been
able to work with our colleagues in the US to
address this issue but the message to us was
clear – we cannot rely solely on Google
referrals to ensure patients have access to our
information.
GP System Suppliers
Patient and GP input in LTOL is increasingly important
ACB News | Issue 621 | January 2015
The difficulties with website traffic have been
a key motivator for Lab Tests Online-UK to
work with other website providers, such as
NHS Choices, and with GP system suppliers to
embed direct links to Lab Tests Online-UK
within their products. Our aim is to provide
hyperlinks directly to information about
specific laboratory tests when and where
Patient Power | 17
from GP record systems. Working with third
parties is going to become increasingly
important as more software tools come onto
the market with functionality to collect and
display patient results. We would encourage
any members who come across any such
products that we may not be aware of to get
in touch with Stuart Jones, (Technical Lead)
stuartjones3@nhs.net so we can consider
working with the supplier to help improve
experience for their users.
The free Lab Tests Online mobile app
continues to attract users with us recently
passing 10,000 downloads.
UK Editorial Team
Danielle leading the celebrations
patients need them. This work has become
particularly relevant with the NHS England
announcement that all patients in England
should be given access to their electronic
health record by April 2015. Our recent work
with GP (and third party) system suppliers has
been particularly fruitful. We now have
test-specific links embedded against patient
results within TPP’s SystmOne patient portal
and we are working with INPS and eMIS to do
the same with their portal applications.
We are also working with third parties, such as
HealthFabric, to embed links in their personal
care planning tool, which also collects results
The UK site continues to be extremely grateful
to all of its editors, who voluntarily edit the
pages of Lab Tests Online-UK, to ensure that
the content is factually correct, consistent with
UK practice and national guidelines, and
written in a style that is appropriate for
patients. Over recent years, the pool of editors
has grown, and editors span all disciplines of
laboratory medicine. The team are always
keen to welcome new editors, in particular
from the more specialist areas such as genetics,
cytogenetics and molecular testing.
Any keen GPs would also be welcomed.
Please contact Dr Sally Stock (Managing
Editor) sally.stock@nhs.net for more
information. ■
Issue 621 | January 2015 | ACB News
18 | Personal View
Clinical Biochemistry into
the 2020s
Jonathan Berg, Birmingham
The organisers of a recent conference gave me
a challenge, asking me to speak to 200 people
on what we might all be experiencing in the
2020s. For some of us of a certain age life may
well have moved on, certainly the free bus
pass beckons for me not long into the next
decade.
Well straight after a coffee break can be
good for audience participation with the
question: “What three things would you most
like to sort out in your clinical science
laboratory?”. However, there was complete
silence. No matter I had already asked my
Pathology team what they thought and had
come prepared with my own shortlist of
pathology conundrums.
My own Pathology team answered this
question at the start of a recent management
meeting. Their comments are probably
reflective of the aspirations of the rest of the
country.
Here are key things to address for the 2020s:
Pathology History – Learn from the
Past
We have lots in common in our pathology
laboratories. During the time of huge growth
in the 1970s and ’80s new technology
including mechanisation, automation and IT
were key to coping with demand. Of equal
value was the drive and determination of
individuals who had foresight and
determination to take laboratory medicine
forward for patient benefit. In my own
discipline and locality I know the pioneering
names Whithead, Sammons, Gaddie, Green
and Broughton but living in Scotland I might
equally say Morgan, Whitby, King and
Percy-Robb. The lack of such a pool of
determined, scientific and strategic thinkers in
recent times has allowed an overindulgence of
central managerial influence. Of course this is
Aspirations
Tell It Straight . . .
GP samples spun down within 4 hours
and overcome high potassium artefacts
forever
Will we ever get there?
Poor quality samples from GPs are a continuing
disgrace.
No more lost samples
Where do they all go? What about the racks of
“orphan” samples we all have on our benches
with no names on?
Specialist services in a falling market
We have done well in my own laboratory.
It takes real determination at present to keep
specialist services alive when everyone is trying
to restrict what they spend on “send-aways”.
More Twitter followers for
@FitPathLab and @cityassays!
No-one admits to using Twitter in our
environment. We have found it incredibly
powerful for getting our message out to people
we did not even know existed. Seriously though
communication is key to future success in
Pathology.
Jonathan’s key things to get right for the 2020s!
ACB News | Issue 621 | January 2015
Personal View | 19
Aspirations of Pathology
Sideways View . . .
Reasonable financial target please
not impossible CIPs
We have always met our CIP, but taking 9.5% out
of the budget in one year is too much!
Appropriate levels of skilled staff
We are all fighting each other for trained BMS
staff at present. Demographics are against us.
Home grown staff is clearly the one and only way
forward.
Assess savings across healthcare
economy not just Pathology
Will it ever happen! Service line reporting is not
the answer.
More IT and better Pathology transport
True, but expensive.
Views of the Pathology Directorate
a vital ingredient but the focus on networking
and consolidation can, if we are not careful,
rather miss the point. Our future success will
be founded on providing relevant laboratory
medicine to patients, not amazingly efficient
U&Es of little end-user value.
We need to remember that not that long
ago the day’s work in a busy clinical laboratory
could all be written into a diary! On my
birthday in the laboratory in West Bromwich
just 10 samples were analysed, all written into
a desk diary!
taxpayers money and NHS effort has been
wasted on failed projects. There are one or
two areas of the country where major changes
have been made, including involvement with
the private sector and we will be able to
observe how these experiments pan out.
Letts day to a page diary with Hallam Street Hospital
biochemistry results for 1956 all neatly entered
Clear Strategy
Well we have our feet on the ground in my
Pathology Department. Key components of
our own strategy are:
◆ Do the basics well.
◆ Innovate with IT and work on the basics
and continuous quality improvement.
◆ Develop new tests of relevance to our
own patients that are also of interest to
others.
◆ Continue with the direct to public services.
These will always be a work in progress but
many of the ways we are moving forward can
be positioned under one of these aspirations.
Much comes along to influence strategy and
of these tendering is important to get right.
Certainly with GP tendering there are no great
success stories. If you look from Sussex,
Hampshire to the Midlands huge amounts of
Issue 621 | January 2015 | ACB News
20 | Personal View
Get the Basics Right . . .
Not That Easy!
Timely and relevant tests
About having correct procedures in place but
also commitment of all in the process.
Helpful support and advice
The friction between the “duty biochemist” role
and the developmental section leader is ever
present in my laboratory.
Relevant POCT
Not a panacea to everything and needs a lot of
central control to do well.
Extend use of IT: Test intervention,
harmonisation, sample tracking, etc
Use IT to increase efficiency and effectiveness,
not create more mess for the end user.
Communicate with and involve staff
Sort of what SWBH is known for, but on our
staff questionnaire communications always
scores badly.
Key things we continually work on
In my own department we had several tenders
live at any one time all through 2014. Recent
examples include a tender for Cytology in 2013
which, when won by a neighbour, meant the
closure of our service and twenty staff leaving
our employment. Specialist services can be
undermined by tendering and this is
particularly the case in Toxicology, where
partnering with just one or two Mental Health
Trusts can be very risky if re-tendering takes
place every three years.
Innovation & Entrepreneurship
Not a way many have chosen in recent times
and not for the faint hearted during times of
healthcare austerity. You need to have a vision
and be able to back a 50/50 idea. When you
know you are right then sometimes time is
required for the rest of the world to catch up.
Entrepreneurial services such as TPMT and
Infliximab being examples, albeit at different
stages of maturity, of the long-term approach.
Being in the right place at the right time is
more than a “fluke”. The SWBH legal highs
service presently being used by labs across the
country demonstrates another angle of
ensuring our services address clinically relevant
issues. Our young people killing themselves by
taking in these horrendous substances is
certainly relevant and this has put us into the
ACB News | Issue 621 | January 2015
forefront of a huge clinical and political issue
in 2014. I could write a whole article about
entrepreneurial Pathology next time
ACB News lacks material, but really the key is
that you either understand it or you don’t.
Clinical scientists in my laboratory mainly
understand this. Some of what we do is highly
intuitive, especially where new ideas transfer
to a service for others. Pathology has been
ignoring marketing communications to its
detriment for far too long and it is very clear
that most Pathology Laboratories still do not
“get it”.
With Whom We Work
Understanding who we actually work for into
the future and something of their direction of
travel is essential. Many of our parent Trusts
are focussed on a short-term balanced budget
and this can override sensible medium and
longer term strategies. You need to change
your approach during such times, working on
different ways of achieving fundamental
objectives. Those around who we interact
with, such as CCGs and other provider Trusts,
also need to be understood. So, when the
CCG negotiates a block contract with your
Trust for everything including Pathology we
need to understand the impact. If your
local Mental Health services provider is just
Personal View | 21
about to lose their main contract for provision
of alcohol and drug addiction there are
consequences. Healthcare sectors such as
Mental Health are changing fast and impacts
on local and national services can be predicted
if you have someone at the top of your
Pathology organisation looking at the
politics.
For us successful working with CCGs is more
of the following:
◆ Pathology work is moving into
◆
◆
◆
◆
Community and funding from CCGs
must reflect the cost of doing the work.
Discuss individual services at a senior
level.
Marketing communication needs much
more emphasis.
GP transport needs continual
improvement.
Produce KPIs for your GP service by
interacting with your CCG even though
you do not have to!
CCGs really do appreciate direct talks with
senior staff and it is essential you meet the GP
leads and interact with them. We are currently
setting up meetings to put in place KPIs similar
to those in a failed GP tender, which some may
consider make a rod for our own back but
others can observe as very astute and actually
ISO 15189 compliant.
Pathology Finance
For the last eight years I have delivered the
Cost Improvement Programme (CIP), for a year
or so rebadged as Transformation Saving Plan
(TSP). In 2005 we had to find 4.5% of our
budget and for the last three years it has been
8%. This has been difficult and has included a
lot of skill mix changes, loss of staff and also
efficiency of non-staff areas of the budget.
There comes a time when if cost pressures
money is not put in on the other side of the
equation the Pathology Director has to say
“We cannot deliver a safe and fit for purpose
Pathology service and make these savings”.
Automation solutions have not delivered staff savings and downtime can be a real issue
Issue 621 | January 2015 | ACB News
22 | Personal View
Getting out with Glen on the
GP transport run gives a real
insight into how we interact with
community services
Equipment
Let us be very candid, we pretty much get the
equipment offer that the big diagnostic
providers think we should have. A year or so
ago you struggled to see anything other than
track based approaches in response to
tendering in Blood Sciences. However, the
huge issues with the implementation of this
technology and the lack of the promised
manpower efficiencies make us question if this
is the future. One thing is certain, relying on
just one diagnostic supplier for our main
platforms can cause real pain when a method
is withdrawn overnight. Managed service
contracts never seem to work out as attractive
in practice as on paper and of course this VAT
loophole may be on borrowed time.
Pathology People
The right mix of staff with appropriate skills to
take our service forward is vital. Why on earth
we cannot employ staff on a probationary
contract I do not know. Bank workers have
been key to keeping many services going, and
we have some excellent staff employed now
on long term contracts who started on the
‘bank’. Sickness records in the NHS including
Pathology would not be tolerated in the
Private Sector but we have Public Sector HR
policies. Having been fortunate enough to
have taken <5 days sick in 36 years in the NHS,
I struggle when I see young, fit and healthy
staff who have had five or more episodes of
short term sickness in a year – usually just
ACB News | Issue 621 | January 2015
under the sickness review barrier. Retaining
good staff is really key to the 2020s but being
able to ’let go’ those who really do not want
to commit to our environment is also
important.
Skilled and highly trained BMS staff are our
backbone. I have considerable issues with the
need to have an IBMS registered Biomedical
Science degrees to enter the profession.
I know the IBMS say this is the HCPC who
demand this … but what a crazy thing that
people who have excellent science degrees are
told they have to pretty much do a whole new
degree to progress to registered status.
The change to out of hours payments is
another disaster area. Whatever one thinks
about previous pay rates we are in a supply
and demand arena which is exacerbated by
out of hours enhanced pay differences
between laboratories.
So, these are some of the things I see as
important heading towards the 2020s.
The key thing for me has been the realisation
of a conversation when I interviewed
Professor Gemmel Morgan and a young
trainee some years ago. We were driving back
to Glasgow Airport after a convivial breakfast.
Gemmel asked me what I wanted to achieve in
Clinical Biochemistry in the final phase of my
career. My reply was easy; “To have some
scientifically based fun and make a difference
to patient care”. Well I have certainly had
the fun and we continually work on the
second! ■
Crossword | 23
ACB News Crossword
Set by Rugosa
Well done to those that sent in an entry. The Editor apologises for a couple of errors in the clues. However,
this did not appear to detract with the usual suspects still managing to get an entry in to claim their just reward.
This month we revert to our normal, though anonymous, cruciverbalist along with some more sideways looks
at Pathology.
22 Cook attains our state of being able
to hold no more (10)
25 Liked nothing about abnormal
healing of incision (6)
26 Mathematical function of surgeon? (8)
27 Doctor treats middle-age youth
leader to plan (8)
28 Belief there is no law about holy
water (6)
Across
1 Pale person upset
old-fashioned England (6)
5 Treatment of ulcers containing
aluminium are nostrums (4-4)
9 Thoroughly eliminated possibility
without me (2,6)
10 Is of help when love affairs
generate no offer (6)
11 Feign truce about apparatus (10)
12
13
16
17
19
21
Down
2 Make surgical incision exceptionally
clean (5)
3 Desist out of disinterest, becoming
inactive (5)
4 It avoided wild variation describing
relation to a gland (7)
5 Laboratory growth last month in
successful treatment (7)
6 Enter silver amalgam for use in
reaction (7)
7 Kind of stimulant used in French
capital (9)
8 Ill-use lab? Make soothing sounds! (9)
14 Corrupt venal unit having one active
site (9)
Distressing xeroderma but
15 Monoclonal antibody producer (9)
no order for test (4)
18 One reused scattered remains (7)
French neurologist corrected
19 Lacking energy for work – strange
– unchastened, sat out (8)
hankering about fortified wine
Tasty scrap to eat or hear (6)
turning up (7)
Flexible part of gun carriage (6) 20 Resolved an ester isomer (7)
Former sort of cherry-red
23 React about suspicion (5)
train (8)
24 Bouquet from our first party;
Travel slowly - intoxicated
we hear you are next (5)
wandering not noticed (4)
Last month’s solution
Issue 621 | January 2015 | ACB News